Although diagnosing concussions may have had its limitations in the past, new research — in the form of a mobile app — is beginning to shed a light on identification and treatment.
Researchers and clinicians within the Cleveland Clinic Concussion Center are constantly studying the long-term effects of concussions, particularly in young athletes. Concussions were once identified with a great deal of subjectivity. A patient would display certain symptoms — such as nausea, dizziness, blurred vision, tiredness, and other unusual behaviors — and if they matched up on a symptom checklist or were identified through an online neuropsychological test, it was likely a concussion. But these assessments did not provide the entire picture regarding the concussion.
“These assessments do a fine job at providing insight into a limited set of neurocognitive symptoms, however, we need to consider functions of the brain,” says Jay Alberts, PhD, Director of the Cleveland Clinic Concussion Center. “The brain is more than a cognitive machine. It is integral in controlling voluntary movement, maintaining postural stability and balance, and integrating information related to cognitive and motor processes to facilitate daily activities like crossing a busy street or even tying one’s shoes. That’s why it’s important to use objective measurement that better reflect brain function or dysfunction in the assessment of concussion.”
Developing a tool for care teams
Dr. Alberts and his team developed the iPad Concussion App two and a half years ago to not only better identify a concussion in patients, but also to help medical teams provide consistent, quality care across a large number of providers.
“The app allows us to gather data in the field, do objective and qualitative research on the concussion, and store the information in the cloud where physicians can access it and consult with one another,” Dr. Alberts said. “The goal is to provide a continuity of care across providers, from the patient’s coach and athletic trainer to their pediatrician and physical therapist.”
Initially created for the iPad 2, which has both an accelerometer to measure acceleration, and a gyroscope to capture trunk (upper body) rotation, the concussion app first identifies what is normal or typical behavior for a player in terms of memory, balance, vision and reaction and movement time. Then, if an athlete experiences a blow to the head, these same criteria are monitored and compared. The app aids doctors in assessing specific symptoms of the concussion, and serves as a guide to better understand recovery and aid in determining when an athlete is ready to go back to the classroom or playing field.
Dr. Alberts explains that the app is fairly interactive. Patients often feel like they are playing a game on their mobile device, but the activities are meant to assess his or her cognitive and motor abilities. The app accompanies players on the field, and is strapped to their lower back during balance evaluations.
Leveling the playing field
The iPad Concussion App is now being used in the clinical practice approach, and is available in the business-to-business store for hospital and athletic training systems. Nearly 12,000 athletes on the high school and college levels have had baseline assessments and more than 1,200 athletes with concussion have been evaluated.
Dr. Alberts says that the app has been deployed everywhere from Harvard University to 60 high schools across northeast Ohio. But his greatest achievement was introducing the technology to a small town in Iowa.
“We don’t always have the ability to translate treatment or medical innovation to the masses in a rapid manner,” Dr. Alberts says. “But when a school in rural Iowa, with well-meaning but under-trained volunteers, is able to utilize state-of-the-art medical technology to better access concussions among their players, we’re raising the bar, while leveling the playing field. It’s technology made available to everybody.”
Dr. Alberts’ research will be presented on Thursday, March 20 from 8:30-9:30 a.m. during the Surgical Trauma Conference at ProMedica Toledo Hospital. The discussion: Addressing Continuity of Care in Concussion with Mobile Technology will be lead by Susan Linder, Associate Director of the Concussion Center at Cleveland Clinic. The event will further explain the iPad Concussion app’s utilization in the medical setting. For more information, please contact the Continuing Medical Education department at 419-291-4176.